Radical Surgery and Adjuvant Therapy for Carcinoma of the Pancreatic Head Region

Akimasa Nakao, Akio Harada, Toshiaki Nonami, Tetsuya Kaneko, Soichiro Inoue, Yuuki Takeuchi, Jiro Hosono, Syuji Nomoto, Hiroshi Takagi

Department of Surgery II, Nagoya University School of Medicine

The resected specimens of carcinoma of the pancreatic head region were histopathologically studied, and postoperative recurrence was investigated. Lymph node metastasis was observed in 70.3% of duct cell carcinomas of the pancreatic head (n=101), 39% of. distal bile duct carcinomas (n=23) and 42.9% of. papilla Vater carcinomas (n=28). Perigastric lymph node metastasis was observed in 11.8% of duct cell carcinomas of the pancreatic head, in no distal bile duct carcinomas and in 3.6% of papilla Vater carcinomas. Neural or perineural carcinoma invasion was observed in 88.1% of duct cell carcinomas of the pancreatic head, 82.6% of. distal bile duct carcinomas and 14.3% of papilla Vater carcinomas. The prognosis of patients with invasion into the extrapancreatic nerve plexus or portal vein was poor in duct cell carcinoma of the pancreatic head. Intraoperative radiotherapy using Lineac combined with radical surgery was efficacious in stage III duct cell carcinoma of the pancreatic head, but not in stage IV. The main cause of postoperative death in recurrence was liver metastasis in these three diseases. On the basis of these results, pylorus preserving pancreatoduodenectomy is indicated in most cases of distal bile duct carcinoma or papilla Vater carcinomas. Prevention and treatment of liver metastasis is most important in combination with radical surgery in advanced cases.

Key words
cancer of the pancreatic head region, pancreatoduodenectomy, intraoperative radiotherapy

Reprint requests
Akimasa Nakao Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
July 6, 1994

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